咽鼓管上隐窝的应用解剖及其临床意义

Applied Anatomy of Supratubal Recess and Its Surgical Significance

目的:探讨咽鼓管上隐窝(STR)对咽鼓管骨部手术的临床意义。方法:对15例(30耳)成人尸头标本和40耳成人颞骨干标本进行了临床解剖学研究,内容包括STR的解剖界限和大小、STR与面神经的解剖关系、STR的临床定位以及咽鼓管骨部的四壁结构等。结果:STR顶壁前后径为(5.28±0.64)mm、内外径为(5.73±0.57)mm、STR顶壁厚为(0.65±0.05)mm。通过STR的准确定位,采用经颅中窝直接开放STR的方法来实施咽鼓管骨部手术是可行的,且无需暴露以锤砧关节为主要内容的上鼓室,故与传统方法相比有手术程序简单化、难度降低及听骨链损伤机会明显减少等优点。此外,STR与面神经的解剖关系提示可经STR内壁行膝状神经节及其附近神经根减压。结论:STR对经颅中窝咽鼓管骨部手术和面神经减压手术均有重要的临床意义。

Objective ：To explore the clinical significance of supratubal recess （STR） in the operation involved in pars ossea tubae pharyngotympanicae. Methods： We studied the anatomical bounds and dimensions of STR, the relationship between STR and facial nerve, the surgical localization of STR and four-wall structures of bony eustachian tube in 15 adult cadaveric heads （30 ears） and 40 adult dry temporal bones. Results：The anteroposterior diameter of the superior wall of STR was （ 5.28±0.64 ） mm, the mediolateral diameter was （ 5.73±0.57 ） mm , and the thickness of the superior wall of STR was （0.65±0.05 ） mm . Directly openning STR via middle cranial fossa is a feasible operative approach for the operation involved in pars ossea tubae pharyngotympanicae, followed the accurate localization of STR. This technique need not to expose the attic in which mainly contains the malleus - incus joint. Compared with traditional procedure, this method has advantages of the simplified operative procedure, lower degree of difficulty, and decreased chances of damaging ossiculax chain. Moreover, the anatomical relationship between STR and facial nerve suggests that the decompression of geniculate ganglion and its nearby nerve roots could be performed through the medial wall of STR. Conclusion ： Applied anatomy of STR has a great significance for the bony eustachian tube surgery by middle fossa approach and decompression of facial nerve.